Objective:

The objective of this work is to identify potential factors that are associated with a higher rate of Postural Orthostatic Tachycardia Syndrome (POTS) treatment changes.

Background:

POTS is a heterogenous disorder of the autonomic nervous system that is often disabling. There are no FDA-approved therapies for the treatment of this condition. While some patients recover with baseline non-pharmacological intervention, others require repeated trials of off-label pharmacological therapies. The reasoning for this variable treatment response is unknown. 

Design/Methods:

Chart review of demographic, disease and treatment descriptions, medical history, and tilt table examinations of 322 POTS patients who were diagnosed between 2018 and 2020 at our tertiary care center was completed. We identified the most significant factors associated with changes in POTS treatment strategies using variable selection techniques and negative binomial regression modeling. A significance level of 0.05 was utilized.

Results:

752 POTS-specific treatment courses were cataloged, and 430 treatment changes were observed. The most cited reason for a change in management was uncontrolled symptoms. History of migraine headaches, reported fatigue, and higher heart rate differences on tilt table examination were found to be associated with an increase in the rate of POTS treatment changes (44%, 66%, 13% increase in incidence rate, respectively), while reported neck pain was associated with a decrease (27% decrease in incidence rate).

Conclusions:

Our work identifies important areas of focus in the development of high-quality trials involving the treatment of POTS and highlights several characteristics of patients that may be more refractory to current treatment strategies.